Integrated care pathway for hip fractures in a subacute rehabilitation setting.

Introduction: The effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. Materials and Methods: A randomised controlled trial on an integrated care pathway for hip fracture patients in a subacute rehabilitation setting. Modifi ed Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture. Results: There were no signifi cant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a signifi cant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no signifi cant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year. Conclusion: Our study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains. Ann Acad Med Singapore 2013;42:579-84